Surgical treatment of aortic valve disease in the Republic of Croatia is a surgical procedure that has a very important place in the overall operating procedures in cardiac surgery centers. According to the reports of all six cardiac surgery centers, aortic valve procedures make up 23% of total procedures performed, which in absolute numbers means 636 aortic valve surgeries in 2014 (Figure 1). In comparison with data from 2012 (1), there has been an increase in the number of aortic valve procedures of about 8% during the last three years. This is in line with the needs based on the incidence of the disease, especially coronary pathology that stands side to side with coronary pathology with which it shares risk factors and similar pathogenesis. We do not have data on the overall prevalence of these diseases in the general population, but if a projection of the incidence of aortic pathology in the Republic of Croatia was made from an European perspective, the need for surgical procedures would be estimated to be much higher. (2) However, observed trends are encouraging and require further monitoring, as well as encouragement to achieve optimum results regarding better prognosis quoad vitam and quoad valetudinem in patients undergoing surgical procedures in comparison to those who do not undergo surgery. (3, 4)

Comorbidity of aortic stenosis and coronary heart disease is high, as our results over the last year indicate. The percentage of combined surgeries with aortic valve replacement (AVR) and aortocoronary bypass implantation (ACBP) was 31%, and the percentage of isolated aortic valve replacement procedures was 69% (Figure 2). The prevalence of combined aortic valve procedures is still somewhat lower in comparison with data from some European registries. Coexistence of aortic disease and coronary heart disease can be up to 37% in severe aortic stenosis cases, and even higher in moderate and mild aortic stenosis. We do not have any data on these relationships in our population.

The types of surgical procedures performed in 2014 in Croatia are shown in Figure 3. Aortic valve replacement, using either mechanical or bioprosthetic valves, is the most common. Mechanical valves are slightly more common than bioprosthetic valves. Aortic valve repair is also present in small numbers (3%). Aortic valve repair is still reserved for aortic regurgitation, which has a lower prevalence (Figure 4). The other reason for the small number of aortic valve repair procedures is the complexity of the procedure. With the standardization of two techniques (the David Tirone procedure and Yacoubu procedure, i.e. its modification by Emmanuel Lansac) we can expect an increase in aortic repair instead of replacement. Implantation of composite grafts in the ascending aorta accounted for 10% of all aortic valve surgeries. There were relatively few transcatheter aortic valve implantation (TAVI) procedures in comparison with other procedures.